SPC365

Are We Gender-Biased in Prescription Practices? An Analysis of the Portuguese Registry of Acute Coronary Syndromes

Session: Sessão de Posters 51 - Enfarte agudo do miocárdio sem supra ST
Speaker: Carolina Pereira Mateus

Congress: CPC 2024
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 13. Acute Coronary Syndromes
Subtheme: 13.4 Acute Coronary Syndromes – Treatment
Session Type: Cartazes
FP Number: ---
Authors: Carolina Pereira Mateus; Mariana Passos; Filipa Gerardo; Inês Miranda; Joana Lima Lopes; Mara Sarmento; Inês Fialho; David Roque; Em Nome Dos Investigadores do Registo Nacional de Síndromes Coronárias Agudas

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Introduction:</span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Acute Coronary Syndromes (ACS), a prevalent disease spectrum in the 21<sup>st</sup> century, demands prompt diagnosis and treatment. However, achieving optimal guideline-recommended medical therapy remains challenging despite healthcare providers&#39; efforts.</span></span></p>

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<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Objectives:</span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">This study aims to elucidate gender-related discrepancies in the therapy prescribed at discharge following an ACS.</span></span></p>

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<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Methods:</span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">An observational study was performed with retrospective analysis of all patients included between 2002 and 2019 in the Portuguese Registry of Acute Coronary Syndromes (ProACS), a voluntary, prospective, observational, continuous registry of the Portuguese Society of Cardiology and the National Center for Data Collection in Cardiology.</span></span></p>

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<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Results:</span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">This study included 49,113 patients (34,936 men and 14,177 women). Men with ACS were significantly younger than women (64&plusmn;13years vs. 72&plusmn;12 years, p&lt;0.001). Women more frequently presented with Non-ST-Elevation Myocardial Infarction (NSTEMI) (47.5% vs. 43.0%, p&lt;0.001) or Unstable Angina (10.1% vs. 9.7%, p&lt;0.001) than ST-Elevation Myocardial Infarction (STEMI) (37.5% vs. 44.4%, p&lt;0.001). Female patients had a more frequent absence of a planned revascularization strategy (7.8% vs. 6.0%, p&lt;0.001), but also a higher rate of normal coronary angiography (11.7% vs. 5.7%, p&lt;0.001). </span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Left Ventricular Ejection Fraction (LVEF) was similar between men and women with ACS (Table 1), but men had a higher rate of Beta-blockers prescribed at discharge (75.6% vs. 71.0%, p&lt;0.001). Women were more often prescribed mineralocorticoid receptor antagonists (MRA) (11.9% vs. 10.9%, p&lt;0.001) and diuretics (34.2% vs. 22.6%, p&lt;0.001).</span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Men had a higher prescription of aspirin, P2Y12 inhibitors, and statins, while women were more likely than men to receive nitrates, amiodarone and digoxin (Table 1).</span></span></p>

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<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Conclusions:</span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Based on the available data, it remains uncertain whether the differences in prescription of aspirin, P2Y12 inhibitors, beta-blockers and statins could be explained by the higher rate of normal coronary angiographies in women and, therefore, alternative diagnoses.</span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Women received higher rates of diuretics, MRA and anti-arrhythmics (amiodarone and digoxin), likely associated with the increased incidence of Heart Failure (HF) and Atrial Fibrillation during hospital admission. Interestingly, the higher incidence of HF does not correlate&nbsp;with a worse LVEF, adding complexity to the interpretation of these associations.</span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The absence of a planned revascularization strategy in more women than men might explain the higher prevalence of nitrates and calcium channel blockers, but does not explain why women receive less statins or anti-platelet agents.</span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In conclusion, this registry shows substantial gender-based discrepancies in prescribing practises for ACS patients, which should be addressed in order to improve healthcare equity.</span></span></p>